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everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA98201 XCOMBINATION ❑ BUILDING <br />❑MECHANICAL <br />❑PLUMBING <br />PERMIT NO. <br />OWNER MAIL ADDRESS <br />CITY <br />ZIP <br />98203 <br />PHONE <br />258-4521 <br />Luther Child Center Box 2097 <br />Everett <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSE 1 <br />Owner <br />CITY LIP <br />PHONE LICENSE I <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSE IF <br />Rucker Avenue <br />Plumbing <br />Everett <br />CLASS OF WORK <br />❑NEW ®ADDITION <br />53ALTERATION ❑REPAIR <br />❑DEMOLITION ❑FENCE ❑SIGN <br />❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />S 8,500 <br />DESCRIBE WORK Remodel existing building to change use from planned laundry room into kitchen - <br />dining area and add 3UU S . tt. OT •'luuu a'\ . <br />1 —.. . <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PROPOSED USE OF BUILDING <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />n <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT _BLOCK_ OF <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />Attached <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />5XIGN RE OF CONTRACT R AUTHORIZED AGENT DATE <br />fG <br />JOB ADDRESS-�� <br />709 46th Street <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF UIPMENT <br />FEE <br />WATER CLOSET JOLIET) <br />AIR COND. UNITS-HP.EA <br />REFRIGERATION UNITS-H.P. EA <br />BATHTUB <br />BOILERS-H.P. EA <br />LAVATORY (WASH BASIN) <br />GAS FIRED A C. UNITS -TONNAGE EA <br />SHOWER <br />FORCED AIR SYSTEMS-B.T.U. M EA <br />KITCHEN SINK & D15P. <br />WALL HEATERS-N.T.U. M <br />DISWASHER <br />UNIT HEATERS-B.T.U. M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER' <br />! <br />CLOTHES DRYERS <br />WATER HEATER <br />�= <br />VENTILATION FAN <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT- C.FIN. <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE -BAR, ETC.I <br />SUB <br />TOTAL <br />S <br />SUBTOTAL <br />PERMIT <br />PERMIT <br />S <br />TOTAL <br />FEE <br />S <br />TOTAL FEE <br />S <br />PLAN CHECK <br />FEE <br />FEE <br />R'g IPT NO. <br />SiUE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />-I <br />r-r <br />So 9" <br />77�D <br />I O s <br />31' <br />s I� <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />@46" <br />FEES <br />VALUATION <br />FEE <br />rj 1 <br />OYES <br />TYPE OF CLNST. - <br />OCCUPANCYCRCUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />SB�JOPJ <br />g- <br />AJ <br />R-/ <br />�- <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />i x a, <br />l <br />PLUMBING A <br />FIRE ZONE BASEMENT HI DOOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />"i;Ko <br />MECHANICAL <br />OYES <br />APPROVALS <br />BY DATE <br />OTHER <br />1. ENVIRONMENTAL CHECKLIST <br />PENALTY <br />BC <br />SJEC <br />SEC. 30$a) <br />2. BUILDING PLANS <br />TOTAL <br />C�c <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED TIN THIS SPACE) THIS IS YOUR PERMIT <br />5. GRADINGILXCAVATION& CLEARINGIGRUBBING <br />DRAINAGE <br />/7 <br />l2q7. <br />7 ENVINONMENUL IMPACT STATEMENT <br />JkUANCE <br />1� <br />B HEALTH DISTRICT <br />PIPM <br />....z^APPLICATION <br />GCS <br />BY <br />APPR FOR ISSBY"!" <br />Y <br />ACC.BY' <br />PLANS CHECKED <br />/L� <br />��f�'�� <br />9-1-79 <br />